Healthcare Provider Details

I. General information

NPI: 1053240903
Provider Name (Legal Business Name): INNERBLOOM MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E CHEVY CHASE DR STE 200
GLENDALE CA
91206-4139
US

IV. Provider business mailing address

1530 E CHEVY CHASE DR STE 200
GLENDALE CA
91206-4139
US

V. Phone/Fax

Practice location:
  • Phone: 626-878-0378
  • Fax:
Mailing address:
  • Phone: 626-878-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN ROSS TROUSDALE
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential: PMHNP-BC
Phone: 626-878-0378